| NPI | 1912225970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IL 125059720) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11015359A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.016540) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125059720) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2015-07-08 |